(a) The family's adjusted annual income shall be calculated by: - (i) Totaling all cash receipts before taxes from all sources for a twelve month period. These sources include:
- (A) Wages, tips, salaries, and commissions before deductions (gross income).
- (B) Regular payments from Social Security, unemployment compensation, Workman's compensation, retirement, strike benefits, and training stipends.
- (C) Alimony, child support and family military allotments, or other regular support from an absent family member or someone not living in the household.
- (D) Payments towards household expenses from other adults living full or part-time in the household.
- (E) Private pensions, government employee pensions, and regular or annuity payments for all family members.
- (F) Dividends, interest, rents, royalties or periodic receipts from estates or trusts for all family members.
- (G) Funds received in the parent(s)/guardian(s) name, through donations, legal action, third party payor, or other sources.
- (H) Savings above an established amount.
- (ii) Subtracting the allowable deductions from the total cash receipts. These expenses include:
- (A) Health insurance premiums paid for any family member in the household.
- (B) Child support paid out.
(b) Financial eligibility will be established by comparing the adjusted annual income and family size to a table based on a predetermined percent of the poverty level determined by the U.S. Secretary of Health and Human Services.
(c) The Program may, at any time and at its discretion, require proof of claimed income and adjustments.
(d) An updated financial eligibility form will be required annually.
(e) The parent or guardian agrees to give assignment of insurance benefits for MCH covered services to the specific MCH providers.
(f) The parent or guardian has signed the application that all information given is true.
(g) Minor applicants who are wards of the court (in Department of Family Services' custody) shall be considered to meet financial eligibility requirements.